Tuesday, November 29, 2011

Choosing a homebirth: My journey Part 1

I know some people wonder where the decision to birth at home comes from. Other people have moved past the wondering and are debating a homebirth for themselves. And still other have had homebirths in the past and continue to choose it for future births.

I can't give answers to all of the people wondering why except to tell them why I have personally done it. I know the journey of one can help the journey of others. I love to hear experiences, expectations, hopes and questions from other people. (Now I have the Yo Gabba Gabba song about sharing in my head!) I am SO thankful that other people shared with me. These people, unknowingly, gave me options

I was sitting with two other women and we were all nursing our new-ish babies. Two of us had typical hospital births, although mine had not gone as desired. I wasn't telling the story of my birth. I didn't even know enough to know what had happened or why. I couldn't even give a voice to my disappointment - I had a typical hospital birth for my area. The same most women had. How come it wasn't ok for me? One friend talked about her hospital birth. She was satisfied. The other friend talked about her homebirth. (WHAT?!?! People do that? Normal people? People with jobs and houses? WHY?! That's so dangerous and irresponsible!!) She was glowing. She was thrilled. She was happy. And I thought she was crazy!

Maybe a year and a half later I was reading the newspaper when I saw an article about doulas. I still have that article. It spoke to me and called me. I went to the website listed (DONA.org) and happily found out that their current headquarters were near me AND they had regular trainings in my area! I didn't know any other doulas. None of them in my area had websites. There was no facebook or myspace and doulas were still pretty new to the birth scene. Nobody had heard of them and a lot of people thought I was crazy. I bought the books I had to read and I started studying. I went to the training with a handful of other women. I was young, it was new, I had very little birth experience and zero natural birth experience. I had judgments and preconceptions. I was idealistic and there was a right way to do everything. (Time, growth, and experience have definitely tempered that for me!) I finally met other doulas and connected with families and I began to attend births.

I have learned so much. Women are strong. They know what to do. They love their babies. Some care providers are good. Some not so much. I also learned what was important to me for my own future births. These were just basic things. Honesty, dignity, privacy, security, confidence, and support. I watched doctors and midwives. I sat with nurses in the halls. I overheard conversations and saw treatment that bordered on abusive. How was I going to have that natural birth I wanted? It wasn't likely to happen.

Before I found out I was pregnant again I started reading about homebirth. I read articles by Henci Goer about the safety of planned homebirth. I already loved her book The Thinking Woman's Guide to a Better Birth and loaned it to most of my doula clients. I talked to other doulas and got the names of some midwives and started calling around. I read books and copied questions. I'm sure those midwives had heard it all a million times. The list below is a pretty accurate description of what I asked. There are probably a ton of these lists floating around online that are all very similar. This one is from San Diego Birth and Wellness. If you haven't checked it out, I would go read Barbara Herrera's (Navelgazing Midwife) awesome series about interviewing a homebirth midwife here. In part 2 I will talk about what made me personally decide on homebirth for children.

Midwifery Education and Experience
What is your philosophy about pregnancy and birth?
Why did you become a midwife?
How long have you practiced midwifery?
Approximately how many births have you attended?
How many of the births you've attended were homebirths?
How, when and where did you receive your education in midwifery?
Did you attend a formal midwifery education program or did you train by apprenticeship, or both?
Are you also a nurse? Are you a licensed midwife?
Are you a certified professional midwife?
Are you certified in Neonatal Resuscitation?
Would you provide me with the names of a few mothers as references?
Do you maintain statistics from your practice?
Have you had any poor outcomes for mothers or babies? Please explain.

Midwifery Practice
Do you work alone or with other midwives?
What arrangements do you have if you are sick or if two of your clients are in labor at the same time?
Will I be able to meet any other midwives who might be involved in my birth?
Do you participate in regular peer review?
What prenatal care do you provide?
What do your prenatal visits consist of?
Do you provide home visits?
What are your recommendations about my nutrition during pregnancy?
What protocols do you have regarding "going overdue" during the pregnancy?
How do you feel about waterbirth?
How many of your clients deliver in the water?
What are your views on episiotomy?
What is your episiotomy rate?
How often do your clients have an intact perineum after the birth?
Can you suture if a tear occurs?
Up to what degree do you suture?
How many third or fourth degree tears have you had?
Do you assist with cleanup after the birth?
How long do you usually stay after the birth?
How often will I see you after the birth?
What do you do during the postpartum visits?
Do you check the baby at each postpartum visit?

What equipment do you carry?
What neonatal resuscitation equipment do you carry? Do you have oxygen available?
What supplies do I need for a homebirth? Where can I purchase them?
Do you have supplies available in the event of a hemorrhage?
How skilled are you at placing IVs?

Practice Guidelines
Do you have a copy of the rules and regulations that pertain to midwifery practice in this state? Are certain policies and procedures for my care mandated by your licensure?
What prenatal tests do you require or recommend?
What conditions absolutely risk me out for homebirth?
How many weeks along must I be in order to be able to have a homebirth?
Are you willing to use a fetoscope instead of a doppler during my pregnancy?
How often do you listen to fetal heart tones during labor?
What are your standards regarding monitoring of the baby during pregnancy and labor?
How frequently do you do internal exams during labor?
How do you feel about having a doula at a homebirth?
Do you provide newborn metabolic screening after the birth?

Childbirth Education
Do you offer childbirth classes? If you refer out to other childbirth educators, which classes do you recommend and why?

Hospital or Physician Transfer of Care
Under what conditions do you transfer to the hospital setting?
Will you or an associate stay with me if I need to transfer to the hospital?
What is the plan of action if hospital transfer becomes necessary?
What consultation arrangements can be made in advance?
What problems or complications in pregnancy would require that a physician would become my primary caregiver?
What is your rate of hospital transfer?
What are the most common reasons for transfer to the hospital?
What is your cesarean rate?
What are the most common reasons for performing a cesarean section?

Complementary and Alternative Medicine
Do you have training or experience in alternative medicine? How did you obtain it?
Do you carry medications, homeopathic remedies or herbs for use during pregnancy, labor and the postpartum periods?
What do you recommend to deal with the common discomforts of pregnancy? Do you generally recommend alternative therapies before pharmaceutical ones?
Do you refer to other providers who give supportive care such as acupressure, acupuncture, chiropractic care, osteopathic treatment and massage?

Availability and Fees
What vacation plans do you have?
Do you have other mothers booked at the same time I am due?
What are your fees and what is included in your services?
Do you use a professional insurance billing person?
In terms of the midwifery fee, what happens if I have to transfer out of your care?
How do I reach you when I need to speak with you? Are you available at all times?
At what point in my labor will you come to me? How long will it take for you to arrive? How do we obtain a birth certificate?
Is there a fee for the newborn metabolic screen?

And finally, ask yourself ....
Do I want this person with me at this most intimate moment of my life?

Wednesday, November 23, 2011

14 weeks

I just figured out my log in info again so I hope to post more often. Wishful thinking :) In the past I have kept pregnancy and birth journals for some of my children. It's not common knowledge yet, but I am currently pregnant with baby #6! A few of my friends have mentioned how much they liked my pregnancy journals and I really hope I can keep up with this pregnancy! I have also had a few friends become interested in homebirth lately so I hope to document the process I go through so they can understand midwifery and homebirth.
My previous birth and pregnancy were unassisted. I have decided to use a midwife this time and am very comfortable and happy with that decision. I've had some anxiety this time about choosing a midwife and whether I wanted a homebirth. I know it's a very individual process and everyone cares about different things and has different ideas of what kind of birth they want. I really enjoyed Navelgazing Midwife's series on interviewing a homebirth midwife. Even though this is the 5th time I've considered these things I liked reading from the point of view of a homebirth midwife. There were a couple things that made a difference to me this time.
We have so many amazing midwives where I live and each one of them brings something different to a birth. I hope there is a midwife for each woman; someone they can work well with who will be a good mentor during the pregnancy and birth. I had a new option in my community this time. A midwife here has opened a small birth center. I don't feel like it's a good fit for me, but such a cool opportunity for women who aren't comfortable at their homes for whatever reason.
On to pregnancy news - I'm due the end of May. We are super excited to have a new baby. I am happy to have a baby at the end of spring. I have too many fall/winter babies and I don't love that time of year. I have been feeling small movement for a couple weeks now. We first found the heartbeat around 10 weeks or so. It was 169. I didn't start to feel very crappy until about 7 or 8 weeks. And then I got sick! I had a nasty cold/cough that kept me down for a couple weeks. I have a few lingering issues with it still, but overall I am feeling pretty good now! I have been anxiously focused on choosing where to birth and with whom and I feel a lot better about that now after talking with a few midwives over the past couple weeks.

Baby #3

This was written in December 2004.
The past few months of this pregnancy I had been worried that I would go into labor in the middle of the week during the day and Jay would miss it. We would also not be able to afford for him to take any time off from work so I was desperately hoping to go into labor late on a Friday afternoon. (I did with both of my girls) The Friday I was hoping for (the 10th) came and went. My due date(s) came and went. I made it to my last childbirth class and got a great foot rub from Jay. Friday (17th) we decided to put the girls to bed and watch a movie, eat junk food, and get a little lovin since we knew we would probably be busy with a baby soon (who am I kidding? I was convinced this kid wasn't coming. I hadn't done pregnancy pics or a belly cast!).
Olivia woke up around 4:30 and got into bed with us. We were going back to sleep when she asked for water. I got up and got the water and went back to bed. I was just falling asleep when I had a contraction. It just felt crampy and I cursed myself for eating so close to going to bed. I had another one and another and thought that maybe this was it. I decided to wait to have 2-3 more and then I would wake Jay up. (still convinced I was not having a baby). I lay in bed, snuggling Olivia and listening to Jay breathe beside me and I felt calm. The few weeks prior whenever I thought about actually going into labor I would feel a little panicked. I had 2 more contractions and by then I knew I wasn't going back to sleep and even though I wasn't super uncomfortable I needed Jay to get things ready while I rested. It was then that he mumbled something to me and I realized he wasn't asleep either. It was about 5:00 by this time. I told him the baby was coming and he said, "right on", and jumped out of bed and got dressed. He started setting the pool up and I stayed in bed hoping Olivia would stay asleep and trying to rest and relax as much as I could.
Olivia decided she was getting up so I decided to move around and try to find a comfortable position. I wanted to get in the shower and have the water spray my back but I didn't want to use all the hot water. I sat on the toilet instead and that felt good but I started to get cold. I walked around a little and then tried to lie down for a while. That didn't feel good at all so I got on my knees and leaned against my birth ball. I felt a little bit like I might throw up (again cursing the food I ate before bed) and went into the bathroom where I stayed on my knees leaning against the bathtub. Jay decided to time contractions and they were 2 minutes apart and a minute long. He called our midwife and left a message on her phone and we got back to business.
I was rocking through the contractions. They were coming fast and hard but I was still chatting nicely in between them and telling Jay how they felt and what was working and what wasn't and what I wanted to try. The pool had some water in it by this time and while I hadn't really been planning to definitely use it, I needed something else. I jumped in and even though it wasn't as hot or deep (yet) as I wanted it, it was nice. Jay started heating up more water and I just hung out. Olivia decided then to come get in the pool with me and Jay ran in to distract her and she got really upset. I wanted Jay with me and I didn't want Olivia upset so I had him call my mom to come sit with her. We gave her the video from the baby (Peanuts Christmas) and she went out to watch that.
Jay came and sat with me and pressed on my back and talked to me and held me. It was so incredible. I was feeling some weird pressure so I reached in and the baby's head was just two knuckles deep. I could feel the little head and the slipper bag of waters. I decided then that if the head were that low I was dilated enough to push. I told Jay I could feel the baby's head and asked him if he wanted to feel and he was just awestruck with it. He thought it was so awesome that he got to feel his baby before it was even born!
I was switching from being on my knees and leaning on the pool to a half kneel-squat. I pushed a little bit with a contraction to see what it did to the pressure but it didn't change a whole lot so I figured I would just wait. I was still talking to Jay and feeling like I was doing really well. My mom came sometime and I even joked with her a little bit and talked to Olivia during a contraction. Around this time whenever a contraction would end I would tell Jay how much it hurt. His arm was probably worn out pushing on my back but it felt so good. He turned on the hot water again and held the hose on my back and that felt great too. I told him I didn't want to do this right now I was tired and I wanted to go back to bed! I'd just finish later. It was then that I decided to just push the baby out. Jay felt for the baby again and it's head was only one knuckle deep this time! I was kneeling and started pushing but the pressure was just too much being that upright. I sat down and pushed a little bit but the pressure was sort of freaking me out. It was so incredibly intense and I wasn't expecting it to hurt but it was really uncomfortable. (go figure! I had a head in my vagina!) I just sat there for a minute and Jay asked if we should call the other midwife who said she would come. I told him to tell her I was pushing and he called her at about 6:30 and she got on her way. I tried a really big push then and I could feel the head trying to come out but I could also feel myself ripping apart front and back. I kind of started freaking out and thought that I could probably just claw the amniotic sac to pieces and then it would feel better. I could actually picture myself doing that and I had to just tell myself to calm down - it was going to be over soon. I laid kind of on my side and tried to slow myself down but then figured, what the heck - if I'm going to tear I'm just going to get this over with! And I did. I pushed and I could feel the pressure and my water wasn't breaking and I was pushing and the head was coming and I was pushing and my water was still not breaking and the head was still coming (how big is this head!?) and then the head was out and I expected that little relief and a rest but I was still being ripped apart and the pressure was still there and my water was still not breaking so I pushed again and the chest slipped out and the water broke and there was the baby! It was 6:35 and he was looking around and he snuggled into me and he was kind of trying to breathe and his cord was around his neck and his belly. Jay just started crying and I told him we needed to unwrap the cord so we did and while we were doing that I noticed it was a boy! I said, "hey! It's a boy!" and Jay was like, "a boy?!" and it was. It was a boy. And Jay held me and I held our boy and we all whispered to each other and smiled at each other and then he let out a loud cry and suddenly my mom was there and I just said, "ooops!" (being that there was no midwife there and she had been concerned about when one would show up) "oh, it's a boy!" and she got Olivia and Olivia saw her brother and told him she loved him and she was excited to touch his hands. My mom went to wake Anicka up but she just said, "tell mom I'll see him tomorrow", and she went back to sleep.
We snuggled and laughed and I told everyone a million times that it hurt to push him out. I had another contraction about 10 minutes later and I started to push but the placenta just kind of fell out. It was large and lovely and Jay put it in a bowl. He called our midwife then and she was on her way. We sat in the pool until it started cooling off and I handed the baby off to Jay. I was sitting in the water thinking about getting up to go into the bathroom when my midwife got there (20-30 minutes after the birth) and she helped me. That shower was wonderful and Jay and my midwife examined the placenta and it was nice and big and pretty with spots of calcification. An hour or so later after I was settled in bed I cut the (very goopy) cord, we weighed him (7 pounds 3 or 4 ounces), measured him (20.5 inches long) and dressed him. He was supposedly born 2 days after his due date but we think he was closer to 41 or 42 weeks. I'm very sure of my dates but my cycles were weird since I had just started ovulating again and then a miscarriage so that probably threw it all off.
So it was a wonderful birth and he is a wonderful baby. He sleeps well and eats well and he's calm and happy. My labor was great - easier than Olivia's but pushing was a lot harder even though it only lasted a couple minutes. I watched my video a couple of days ago and I was amazed at myself - how coherent, happy, calm, and involved I was the entire time. I'm excited and happy that I got my unassisted birth and my wonderful midwife to come take care of me afterward. All in all my labor lasted about an hour and a half and it was fun and exciting and so extremely cool to share it all alone with my husband. He was awesome, amazing, and perfectly wonderful throughout the entire thing. He makes cute babies and he says I am an amazing birth machine and it is utterly delightful that he is so proud of me.